Natl Conf Hum Retroviruses Relat Infect (1st). 1993 Dec 12-16;:138.
24 year old white male with no history of IVDA and homosexuality
presented initially in December 1991 with Toxic Shock Syndrome.
Investigations at that time led to the diagnosis of HIV infection. His
CD4 count was 4 cells per cul. He was started on Zidovudine, TMP & SMZ
and Fluconazole. He presented with progressive dysphagia in May 1993.
EGD revealed friable esophageal mucosa covered with thick white exudate.
Fluconazole dose was increased to 400 mg/day. In spite of increased dose
of Fluconazole the patients' dysphagia worsened. He was started on I.V.
Amphotericin B and received a total therapy of 500 mg. He showed an
excellent response with this treatment. The fungal susceptibility
studies demonstrated Fluconazole MIC to C. Albicans 10 mcg/ml at 24 hrs.
20 mcg/ml at 48 hrs. and MLC greater than 80 mcg/ml at 24 hrs. Patient
was restarted on oral Fluconazole for prophylaxis, however his clinical
symptom recurred. He has shown a moderate clinical response to
Itraconazole. Our case study demonstrates failure of Fluconazole to
treat Candida Esophagitis in a severely CD4 depleted patient with HIV
infection. Antifungal susceptibility studies may not be helpful in these
Candidiasis, Oral/COMPLICATIONS/*DRUG THERAPY Fluconazole/*THERAPEUTIC
USE Human HIV Infections/*COMPLICATIONS Pharyngeal
Diseases/COMPLICATIONS/*DRUG THERAPY Treatment Outcome ABSTRACT